More investment for NHS but not social care is ‘like pouring water down a sink’

A push to get people discharged from hospital more quickly is partly contributing to a rise in those needing more complex care in the aftermath, according to a major survey of adult social care directors.

A more-of-the-same approach will not work, a prominent membership organisation for those working in adult social care in England said, warning that investment must shift from a focus on freeing up hospital beds to better funding for social care.

The results of the Association of Directors of Adult Social Services (Adass) spring survey are said to paint “an unsustainable and worrying picture” and are billed as “essential reading” for new Health Secretary Wes Streeting and care minister Stephen Kinnock.

Responses from 95% of the 153 English councils with social care responsibilities suggested the number of people needing more complex council-funded care, with multiple visits from two or more care workers – known as “double-handed care” – rose by 7.4% in the year to March, to 48,955 people.

Adass said this is reflected in the increased amount of time councils are providing for care, with 750 hours of homecare on average in 2024, up from 697 hours in 2022.

Council spending in this period on homecare was up by just over a quarter (27%) and around a quarter of directors reported increases or significant increases in the size of packages of council-funded care from community-based settings in 2023 last year.

The report stated: “Too often higher numbers of people discharged from hospital result in more people waiting at home for social care, or discharged to care homes that they never leave – many of whom will inevitably deteriorate, leading to higher needs in the longer run or even hospital readmission.”

Adass described a financial situation “as bad as it has been in recent history” when it comes to adult social care budgets, with a £586 million overspend in 2023/24 and “an increasing reliance on one-off reserves to prop up budgets”.

Its survey showed that 90% of directors either have no confidence or are only partially confident their budgets will be sufficient to fully meet their statutory duties in provision of social care in 2024/25.

The pressure on councils to provide more hours of complex care and support means people needing low-level and early support at home “are at risk of missing out or their needs escalating”, Adass warned.

Its president, Melanie Williams, said: “This report shows an unsustainable and worrying picture for the four out of five of us needing adult social care in the future and sends a clear message that we can’t keep doing more of the same.

“Instead of focusing on investment in hospitals and freeing up beds, the new Government must shift to investing in more social care, supporting unpaid carers, and providing healthcare in our local community to prevent people reaching crisis point and ending up in hospital in the first place.

“Without investment in early care and support at home or the community, spending more on the NHS is like pouring water down a sink with no plug in.”

The insight into the current state of play for councils comes as Healthwatch said its research suggests more than a quarter of working-age disabled adults in England could be eligible for some form of social care support but have never had a needs assessment.

The independent body, which describes itself as a health and social care champion, said its polling of 1,504 working-age disabled adults in England indicated that almost two-thirds did not think they were entitled to support, a quarter were unable to afford to pay for care or contributions, and more than one in 10 (14%) found it too difficult to get support from councils or the NHS.

Healthwatch said that, based on the most recent estimates of there being approximately 5.4 million working-age adults with a disability in England, its survey results suggest there could be around 1.5 million people across the country eligible for support who have not been assessed.

Its chief executive, Louise Ansari, said: “Not all these people will be eligible for publicly funded care, but far too many clearly live with some form of unmet need and don’t know where to turn for support.

“We need to make sure there is more support for disabled people, and that this support is easy to understand and to access.

“Not only will this help people with their emotional and physical needs, but it will also help people who have told us they’d like more support to get into work, and it will contribute to taking pressure off NHS services.”

Skills for Care, the strategic workforce development and planning body for adult social care in England, is due to launch its new workforce strategy for adult social care on Thursday.

It has previously said the strategy will identify the workforce needs over the next 15 years and produce a plan for ensuring the sector has enough of the right people with the right skills.

A spokesman for the Department of Health and Social Care said: “We are determined to tackle head-on the significant challenges social care faces.

“We will undertake a deep-rooted programme of reform to create a National Care Service and make sure everyone gets the care they need.”